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Monday, November 23, 2009

The Cost of Dying

“The Cost of Dying,” which aired Nov. 22 on CBS News’ 60 Minutes explores the incredible amount of money spent on healthcare at the very end of people’s lives. It was an extremely timely and valuable program. As end of life care is brought to the forefront of the health reform debate, it is worth taking some time to watch the video below.

In 2008, Medicare paid $50 billion for doctor and hospital bills during the last two months of patients' lives – with as much as 20 to 30 percent deemed to have had no meaningful impact, Steve Kroft reported.

Marcia Klish is either being saved by medical technology or being prevented from dying a natural death.

She is 71 years old and suffering from the complications of colon surgery and a hospital-acquired infection. She has been unconscious in the intensive care unit at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., for the better part of a week.

One of her doctors, Dr. Ira Byock, who heads the palliative care program at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH., told 60 Minutes correspondent Steve Kroft it costs up to $10,000 a day to maintain someone in the intensive care unit. Some patients remain here for weeks or even months; one has been in the ICU since May.

"This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU," Byock said. "And, you know, it's extremely expensive. It's uncomfortable. Many times they have to be sedated so that they don't reflexively pull out a tube, or sometimes their hands are restrained. This is not the way most people would want to spend their last days of life. And yet this has become almost the medical last rites for people as they die."

"Families cannot imagine there could be anything worse than their loved one dying," said Byock. "But in fact, there are things worse. Most generally, it's having someone you love die badly - dying, suffering, dying connected to machines."

A vast majority of Americans say they want to die at home, but 75 percent die in a hospital or a nursing home.

"How do so many people end up in the hospital?" Kroft asked Dr. Elliott Fisher, a researcher at the Dartmouth Institute for Health Policy.

"It's the path of least resistance," Fisher said.

"The way we set up the system right now, primary care physicians don't have time to spend an hour with you, see how you respond, if they wanted to adjust your medication," Fisher said. "So, the easiest thing for everybody up the stream is to admit you to the hospital. I think 30 percent of hospital stays in the United States are probably unnecessary given what our research looks like."